HIStalk Practice Interviews John McConnell

John McConnell is president and owner of McConnell Golf. He co-founded Medic Computer Systems (acquired by Misys in 1997 for $923 million, now part of Allscripts) and was chairman and CEO of A4 Health Systems (acquired by Allscripts in 2006 for $272 million). 

You left Allscripts and the HIT world four years ago. What have you been doing since then? 

I started McConnell Golf in 2003 when I purchased Raleigh Country Club while also being CEO of A4 Health Systems. After that company’s sale to Allscripts in 2006, I wanted to pursue a new industry challenge and have focused on growing McConnell Golf. Today we own eight clubs and employ over 500 people. McConnell Golf  hosts the Wyndham Championship, which is a PGA event at one of our clubs in August,  as well as a Nationwide Tour event in June.

Do you think today’s business and HIT environment could support startup companies similar to the ones you built with Medic and A4?   

There will always be room for new companies and new products. At Medic, we developed most of our products when I was with that company. At A4, we were much smaller than Medic and other competitors, so we acquired other businesses with established technology in order to get to market faster at lower costs. 

I see the same opportunities today for smaller businesses to be acquired by larger HIT entities due to time and the research and development investment required to create and execute on new ideas. On numerous occasions, I am asked to review new products that small startups are developing, and many are very good ideas that can fulfill a niche in HIT. Certainly I think developing large-scale, enterprise-wide solutions would not be the best place for small companies to invest and compete today.

If you were starting an HIT company today, what area would you choose?  

Analytics. Information from the various HIT systems tied together to help reduce costs, eliminate service redundancy, identify fraud, and improve patient care will be huge.

Is healthcare software becoming as commoditized as hardware? 

Most mature systems are very comparable today, and I see a continued lower-margin business for most of the vendors in their software sales. Service revenue is the future for most HIT companies, which is similar to how IBM moved from hardware into consulting as margins in their historic business eroded. 

The same business rules apply today as in the past. Those companies that can gain customers with efficient marketing and implement their solutions in a timely and cost-effective manner will gain market share. Pricing will continue to drive a lot of buying decisions. Web-based solutions are quicker to build, implement, and maintain, so lower pricing should be the norm for the customers.

What are the good and bad aspects of Meaningful Use? 

I think Meaningful Use will help control the ongoing rise in healthcare costs going forward if it is given time to succeed. Having greater automation and less paper will be good for everyone. Technology helps reduce costs and errors in delivering healthcare services, so those are positive benefits. 

Bad aspects may be that caregivers spend more time documenting and looking at computer screens than with the patients. I also see the trend for the older physicians to retire sooner than later as their reimbursements are reduced further by not implementing technology.

Who in the industry do you really admire? 

My top three in no order of preference are Neal Patterson from Cerner, as he had a long-term vision for HIT and never let the Wall Street crowd interfere with it. I admire Judy Faulkner at Epic because of her emphasis on software, company culture, and maintaining the private company status. Patrick Hampson at MED3OOO  has reinvented that business at least three times from its founding in 1995 to adapt to industry dynamics, so that takes sincere leadership skills.

What ugly lessons did you learn running publicly traded companies? 

The biggest issue that I found for myself personally was that I started managing the business to meet Wall Street expectations instead of our customer ones. Each quarter end became challenging for our business and employees because of the pressure and pride we felt not wanting to lose any money for investors that bought our stock. Quite honestly, that caused us to make some poor business decisions in granting discounts or other incentives to our prospective customers at quarter end that we most likely would not have offered as a private business. 

Today I sit on one public board, and the government regulations now in place for public companies are very challenging and expensive to manage. Personally, I also see more investors looking for short-term results in stocks that they buy instead of valuing the company’s long-term potential. However, even with the negative issues that I have outlined, public markets provide valuable capital to businesses to grow to new levels that benefit many.

Allscripts is in the midst of a rough patch with its recent board turnover, missed earnings, and drop in stock price. Do you think this is just a bump in the road or do you predict more turmoil in coming months? 

I have been off the Allscripts board since 2008, so my familiarity with the business is not very current. Their management team has certainly built an impressive business in both revenues and customers, so they enjoy a very strong position in the industry.

Integrating large acquisitions and different product lines in a short period of time will be challenging for any company. That is most likely the major reason why Allscripts recently hit a bump in the road in their business financial results and significant loss of shareholder value. With any board, you often have diverse opinions on the business strategy to pursue, so that can create major conflicts among its members.

News 5/17/12

Emdeon reports its Q1 results: revenue of $286 million, up 5.4%; net loss of $17.3 million versus profits of $7.3 million a year ago. The company attributes the loss primarily to costs associated with taking the company private when PE firm Blackstone Group purchased Emdeon last year in a $3 billion deal.

Kareo releases enterprise-grade claim scrubbing technology that checks for claim errors in real time as billers enter procedure and diagnosis codes.

The MGMA-ACMPE asks HHS to consider a six-month extension on the June 30 deadline for submitting hardship exemption requests to avoid 2013 e-prescribing penalties. The organization says practices need more time to assess their success in reporting for the first several months of 2012, when many practices were facing claim rejection problems associated with the 5010 transition. MGMA-ACMPE also requests the creation of an appeals process to contest past and future CMS prescribing award, penalty, and exemption decisions.

EMR provider Practice Velocity names Carol R. Parks, MD its EMR physician specialist.

3M Health Information Systems announces it will provide open access to its Data Dictionary under an agreement with the DoD and VA. The DoD/VA are integrating 3M’s technology into its joint EHR; the terms of 3M’s agreement requires the company make the Data Dictionary software and terminology content openly available to physician practices and other providers.

The Trizetto Group announces that its subsidiary Gateway EDI has acquired NHXS, a provider of contract compliance and point-of-service adjudication workflow automation. Gateway will incorporate NHXS’s capabilities into its EDI and RCM offerings.

The Tampa Business Journal profiles Vitera Healthcare, formerly Sage, which was purchased by Vista Equity Partners last year.  CEO Matthew Hawkins admits the company laid off a number of workers earlier this year (on the lower end range of 120 to 300) but plans to hire 50 to 100 new employees over the next six months, including individuals with technical and clinical experience. Hawkins also says Vitera will invest $25 million this year to develop a cloud-based version of its software, a native iPad app for Intergy, and a Web-based tool for physician-patient communications.

Austin Diagnostic Clinic (TX) goes lives on PatientKeeper Charge Capture for its 120 physicians.

Pacific Cataract and Laser Institute (WA) says its use of NextGen’s NextPen solution has allowed the practice to streamline its new patient registration process. The NextPen solution, which is based on Anoto Digital Pen and Paper technology, uses a digital pen to capture patient data for upload into the NextGen Ambulatory EHR.

Farzad Mostashari announces that ONC will add a chief medical officer to “infuse a clinical perspective” on all ONC activities with clinical implications, including safety, usability, clinical decision support, MU policy developing, and quality. Jacob Reider MD, who currently serves as a senior policy advisor for the ONC, will serve as acting CMO until a permanent placement is made.

Mostashari, by the way, along with former CMS administrator Donald Berwick, MD and others, co-author a guide for physicians on the EHR incentive program. Berwick notes that even though more than 30,000 clinicians have qualified for incentives, many others are unaware of how to prove they are meaningful users of EHR.

Medical billing company Fi-Med Management announces it will add 145 employees over the next three years as it expands operations. Fi-Med says it has secured preliminary approval from the Wisconsin Economic Development Corp. for a $750,000 loan to finance a new Web-based application to manage physicians’ billing activity.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

Readers Write 5/15/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Health Informatics  [helth in-fer-mat-iks]: A Noun?
By Aaron Berdofe

Health informatics is a term that has garnered a multitude of definitions over the relatively short term it has been in use. Papers have even been written about it, positing definitions containing the synergistic relationship between the disciplines of medicine, operations management, human interaction, and computer science.  

They are all very complicated and important sounding, so I certainly don’t want to deride the academic effort that went into pondering the question of what health informatics is. But, having now completed all of my course work for the Masters of Health Informatics degree at the University of Minnesota, I feel obligated to offer an alternative.  

I am, in fact, now an expert at answering this question. My response has been whittled down from (a) a technical and philosophical lecture (did you know it was derived from the Russian word informátika?), which has eyes glazing over within the first few words, to (b) a succinct statement which induces a thoughtful, "Hmm" before moving on in the conversation.

I wish I could just say something simple, like "I’m a doctor," where people not only understand, but grasp the gravity of what you do. But I’m not one, so I cannot.  

Instead, I have settled for people being able to understand the general idea of what I have been pursuing higher education for and apply through my consulting career, but perhaps not quite being able to connect to how it relates to them.  This remains true even of people within the healthcare industry.  If a little mystery is what makes a man attractive, I am unquestionably worth a second look.

My definition is this:  health informatics is a study of the flow of information through healthcare and how that information is used. Do we deal with computers? You bet we deal with new-fangled technological tools! However, technology no more defines an informatician than a wrench does a plumber. Thus, why I don’t like to include it in my definition.  

The emphasis should be on the information, not necessarily the mechanisms that sometimes help it move.  Is health informatics a multi-disciplinary field?  Certainly, but so was everything else at one point or another. Health informatics is a new field that is diligently integrating itself into healthcare.

Right now, the industry is focused on obtaining clinical information with carrots and sticks (I’m looking at you, Meaningful Use!) through EHRs. Yet the dirty secret is that EHRs can’t actually be proven to be useful in terms of ROI, improved patient safety and outcomes, or practice efficiency. And it’s not the technology that is the problem. Creators of EHRs don’t know what problem their technological solution is trying to solve, but we’ve all agreed that the processes of healthcare should advance themselves into the digital age.  

Therein lies the problem that health informatics will have to solve.  How do we adjust the flow and processing of information throughout healthcare to improve the lives of patients and make it a sustainable business? This question is why I’m in health informatics.  

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s medical and practice management suite and EMR design and development.

News 5/15/12

The AMA asks CMS to consider an additional one-year delay for the transition to ICD-10. Last month, HHS issued a proposed rule that would push the deadline back from October 1, 2013 to October 1, 2014. AMA believes that overwhelmed physicians need a deadline no sooner than October 1, 2015.

e-MDs hires former CO-REC director Robyn Leone as director of public policy and government initiatives.

Barrington Orthopedic Specialists (IL) selects NextGen’s EHR, PM, Portal, and other solutions for its 15-physician practice.

The percentage of doctors using tablets has nearly doubled since 2011, with 62% now claiming to use of some sort of tablet device. The Apple iPad is the preferred device for 81% of the tablet adopters.

ChartLogic announces that six orthopedic groups recently selected ChartLogic EHR Suite.

Twelve orthopedic and radiology practices select Merge Healthcare’s specialty EHR products.

KLAS takes a look at SaaS ambulatory EMRs, which are becoming more popular for providers who want minimal upfront cost and less IT involvement. Overall satisfaction scores were close for the top six vendors: CureMD, Practice Fusion, athenahealth, MIE, MedPlus, and Sevocity .

The 91-provider College Park Family Care Center (KS) contracts with eClinicalWorks for EHR.

A Texas ED doctor develops HealthCareWaitTime.com, a site that allows hospitals and physician offices to post patient wait times online and gives patients the option to schedule appointments and communicate securely with their providers.  Interestingly, Dr. Harvey Castro has developed more than 30 medical smartphone apps over the last few years.

The AMA submits a letter to CMS, asking for less-aggressive criteria to achieve Meaningful Use. Some of the specific suggestions:

• Give physicians the ability to opt out of requirements that don’t apply to their routine scopes of practices
• Limit requirements to actions within a physician’s control and not rely on patients or other third parties’ use of technology
• Eliminate penalties for not meeting MU standards by October, 2014.

Here’s something fun to kick-start your week. Nuesoft creates a parody of Jay-Z’s “99 Problems” to highlight physician frustrations with the ICD-10 transition. If you’d like to be a music video star, Nuesoft is soliciting additional video clips and photos to be edited into the above video.

E-mail Inga.

Practice Wise 5/13/12

IT Investment is Necessary

You’ve picked your EHR software. The vendor likely has provided you with a document outlining the hardware and network specifications needed to support your software. That’s just the beginning of what you ultimately need. It’s easy to be overwhelmed by the technical information about expensive hardware and network purchases and the plethora of individual computer choices. Don’t let overwhelm of the moment cause you to make decisions you don’t fully understand.

You are not alone in your inability make these decisions. That’s how many independent medical practices feel when they buy their EHR and then have to buy the hardware to access and optimize their software. They rely on their software and network support vendors to help them make the right choices for them. From an IT standpoint, this is a hard thing to advise people on, there are so many choices and reasons why some choices are better than others.

Starting with the individual computers, the most common question I hear is, “Should we buy tablets or laptops or full workstations? Thin clients for FAT clients?” Each of these has its pros and cons. There are many factors to consider, these are a few that are driven by individuality vs. technical specifications:

Providers and Clinical Staff

How mobile is their position?

• Nurse/MA: highly mobile, rooming patients, charting, ordering tests – they might be better served with a laptop or tablet.
• Provider: will they chart in the exam room, at a central workstation or go back to their office between encounters? Laptop or desktop purchase based on their individual charting preference, sometimes both are in order.

You want portability. You decided to use laptops. Now which ones? Weight is one of the defining factors for this choice. If you care carrying the machine around all day from room to room, you don’t want to be lugging an 8-pound, 15 -17” laptop.

• Consider an ultra-book. There are several good models on the market with solid state drives that are very light and quick to start up.
• Battery used to be the big decision point, but even those with ‘long life’ batteries end up plugging in throughout the day, so this is less of an issue than we once thought.

You need touch screen or full tablet handwriting capabilities.

• Pure tablets are light and portable, but screen real estate is small. Will the amount of charting and the functionality of your EHR bode well in that environment?
• Convertible tablets, heavier than the ultra-books, are an option for greater screen size than some pure tablets.
• Touch screen laptops. Some are lightweight and give you the option to click your screen and type without rotating the monitor position. Look for solid state drive machines for better performance. These are a good happy medium.
• There are straps that you can put on the base of the laptop/tablet that allow you to slide your hand between the strap and machine, providing a little bit of stability when holding the laptop in one hand and typing or writing with the other.

Front Desk, Billing Department, Admin Users

Stationary workstations work best – thin or fat clients.

• If scanning and taking webcam photos, fat clients work best in the long run. I know, I know — great tools such as remote scan exist, but they are not problem free.
• Consider dual monitors for the billers/payment posters.
• USB ports on the front of machines for ease of accessing temp file shares such as thumb drives.
• Do you need CD/DVD drives for providing electronic chart copies to patients to meet Meaningful Use?

Proactive network support is the biggest decision that is most often overlooked and under budgeted. I don’t know how to convey to small and medium practices that they need to bite the bullet and understand that IT is a sunk cost, and plan for it in their monthly budget. When you were running PM software only, although it was not best practice, you could get away with using your IT vendor for break/fix service calls and new hardware purchases. Now that you are running EHR, you can’t afford to not have a managed services contract with your IT vendor.

Short- and long-range plans for software upgrades and license management, hardware replacements, and ongoing patching and monitoring are all essential elements in maintaining your EHR. Items to consider in your managed services contract:

Asset Management (Both Software and Hardware)

• When Microsoft products upgrade, how long will your versions be supported? How quick is your EHR vendor to develop their product(s) to the latest versions available? This was a big issue with operating systems such as Windows XP. When it was no longer available, clinics needed to buy a new hardware and the EHR didn’t support Windows 7 (or the next versions going forward). Proper asset management includes plans to replace the operating system with any other underlying software that your EHR needs to run in conjunction with your EHR upgrade roadmap.
• Hardware that exceeds its warranty period. How easy will it be to obtain replacement parts? Most hardware vendors do not maintain inventory on outdated parts, forcing you to upgrade your hardware, which can be problematic when it is unplanned. Plan on replacing hardware around the time your warranties expire. The good news is that three years used to be the standard warranty period and most vendors are offering 4-5 year warranties on bigger hardware purchases such as servers.
• Patching and updates. Without someone paying close attention to the regular updates pushed by the software and hardware vendors of all your assets, you may miss vital high priority updates that put your organization at risk for down time, security breaches and data loss.

After 12 years doing this work, I continue to be astonished by the number of groups that don’t see the value of IT managed services contracts. Your EHR is the heart of your business, which is often a multi-million dollar business that supports the livelihood of providers, staff, and their families, as well the care of thousands of patients. Yet in order to save money on the front end, they are willing to risk losing their network and/or data. This is shortsighted thinking that I hope will not prove catastrophic to you in the end.

I’m not your IT vendor and have no financial gain in your decision, but I urge you to review your current IT management solution and get on a proactive managed services plan if you are not already on one.

Julie McGovern is CEO of Practice Wise, LLC.